Spinal implant system and method

ABSTRACT

An interbody implant includes an implant body extending between an anterior surface and a posterior surface. The implant body includes a first vertebral engaging surface and a second vertebral engaging surface. At least one of the vertebral engaging surfaces defines a cavity configured for disposal of bone growth detectable via medical imaging. Systems, spinal constructs, surgical instruments and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to aspinal implant system and a method for treating a spine.

BACKGROUND

Spinal pathologies and disorders such as degenerative disc disease, discherniation, spondylolisthesis, stenosis, osteoporosis, tumor, scoliosis,kyphosis and other curvature abnormalities, and fracture may result fromfactors including trauma, disease and degenerative conditions caused byinjury and aging. Spinal disorders typically result in symptomsincluding deformity, pain, nerve damage, and partial or complete loss ofmobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes fusion, fixation, correction, discectomy, microdiscectomy,corpectomy, decompression, laminectomy, laminotomy, foraminotomy,facetectomy and implantable prosthetics. As part of these surgicaltreatments, spinal constructs, such as, for example, bone fasteners,spinal rods and interbody devices can be used to provide stability to atreated region. During surgical treatment, surgical instruments can beused to deliver components of the spinal constructs to a surgical site.For example, interbody implants can be delivered to the surgical sitefor fixation with bone to immobilize a joint. Such interbody implantscan include bone growth promoting material to enhance fixation of theinterbody implants with the bone. This disclosure describes animprovement over these prior technologies.

SUMMARY

In one embodiment, an interbody implant is provided. The interbodyimplant includes an implant body extending between an anterior surfaceand a posterior surface. The implant body includes a first vertebralengaging surface and a second vertebral engaging surface. At least oneof the vertebral engaging surfaces defines a cavity configured fordisposal of bone growth detectable via medical imaging. In someembodiments, systems, spinal constructs, surgical instruments andmethods are provided.

In one embodiment, a method for treating a spine is provided. The methodcomprises the steps of: connecting a surgical instrument with an implantbody adjacent a cavity of the interbody implant, the implant bodyincluding an opening extending through a thickness of the implant bodyand a recess; disposing the implant body between a first vertebralsurface and a second vertebral surface of a subject body; manipulatingthe implant body between a non-aligned orientation such thatvisualization of the opening is obstructed by a surface of the implantbody that prevents radiographic visualization of the opening and analigned orientation such that the surface is oriented to allowradiographic visualization of the opening; and manipulating the implantbody such that recess is detectable to indicate orthogonal alignment ofthe implant body with the vertebral surfaces.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 2 is a perspective view of the components shown in FIG. 1;

FIG. 3 is a front view of the components shown in FIG. 1;

FIG. 4 is a break away view of the components shown in FIG. 3;

FIG. 5 is a break away view of the components shown in FIG. 1;

FIG. 6 is a break away view of the components shown in FIG. 5;

FIG. 7 is a break away view of the components shown in FIG. 1;

FIG. 8 is a side view of the components shown in FIG. 1;

FIG. 9 is a plan view of the components shown in FIG. 1;

FIG. 10 is a plan view of the components shown in FIG. 9;

FIG. 11 is a front view of components of the components shown in FIG. 1;

FIG. 12 is a perspective view of the components shown in FIG. 11;

FIG. 13 is a side view of the components shown in FIG. 1;

FIG. 14 is a perspective view of the components shown in FIG. 1;

FIG. 15 is an axial view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosuredisposed with vertebrae;

FIG. 16 is a perspective view of the components and vertebrae shown inFIG. 15;

FIG. 17 is a perspective view of the components and vertebrae shown inFIG. 15;

FIG. 18 is a plan view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosuredisposed with vertebrae;

FIG. 19 is a front view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 20 is a perspective view of the components shown in FIG. 19;

FIG. 21 is a cross section view of the components shown in FIG. 19;

FIG. 22 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 23 is a perspective view of the components shown in FIG. 22;

FIG. 24 is a cross section view of the components shown in FIG. 22;

FIG. 25 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 26 is a perspective view of the components shown in FIG. 25;

FIG. 27 is a cross section view of the components shown in FIG. 25;

FIG. 28 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 29 is a perspective view of the components shown in FIG. 28;

FIG. 30 is a cross section view of the components shown in FIG. 28;

FIG. 31 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 32 is a plan view of the components shown in FIG. 31;

FIG. 33 is a side view of the components shown in FIG. 31;

FIG. 34 is a side view of the components shown in FIG. 31;

FIG. 35 is a side view of the components shown in FIG. 31; and

FIG. 36 is a side view of the components shown in FIG. 31.

DETAILED DESCRIPTION

The exemplary embodiments of the surgical system and related methods ofuse disclosed are discussed in terms of medical devices for thetreatment of musculoskeletal disorders and more particularly, in termsof a spinal implant system and a method for treating a spine. In someembodiments, the systems and methods of the present disclosure areemployed with a spinal joint and fusion, for example, with a cervical,thoracic, lumbar and/or sacral region of a spine.

In some embodiments, the present surgical system includes an interbodyimplant. In some embodiments, the surgical system includes an interbodyimplant having one or more troughs or through features. In someembodiments, the troughs are configured to assess fusion and/ororthogonal alignment of the interbody implant with tissue. In someembodiments, the troughs or through features are configured to providevisualization of bone growth adjacent to an endplate of vertebrae. Insome embodiments, the troughs provide indicia, for example,radiographically, which indicates bone growth. In some embodiments, theinterbody implant does not include a trough or through feature. In someembodiments, the interbody implant includes a surface havingmicro-texture to avoid subsidence with tissue.

In some embodiments, the surgical system includes an interbody implantthat can be aligned orthogonally with tissue. For example, the interbodyimplant can define a longitudinal axis such that the interbody implantis manipulable to dispose the longitudinal axis orthogonal to abi-lateral axis of vertebrae. For example, the interbody implant candefine a transverse axis such that the interbody implant is manipulableto dispose the transverse axis parallel or co-axial to the bi-lateralaxis. In some embodiments, the surgical system includes an interbodyimplant having one or more openings that provide indicia of disposal ofthe interbody implant in a selected alignment with tissue.

In some embodiments, the interbody implant includes an elongated openingextending through a thickness thereof such that in an orthogonalalignment orientation of the interbody implant with tissue the openingis radiographically detectable and in a non-aligned orientation isnon-detectable. In some embodiments, the orthogonal alignment andnon-aligned orientations of the opening are detectable for visualizationradiographically in an AP view of vertebrae. In some embodiments, theorthogonal alignment and non-aligned orientations of the opening aredetectable for visualization radiographically in a lateral view ofvertebrae. In some embodiments, the interbody implant includes anelongated recess extending along an outer surface thereof such that inan orthogonal alignment orientation of the interbody implant with tissuethe recess is radiographically detectable and in a non-alignedorientation is non-detectable. In some embodiments, the orthogonalalignment and non-aligned orientations of the recess are detectable forvisualization radiographically in a lateral view of vertebrae.

In some embodiments, the surgical system includes an interbody implanthaving one or more troughs that comprise a void. In some embodiments,the interbody implant includes an arcuate surface that defines the void.In some embodiments, the interbody implant includes one or more troughsdisposed parallel to vertebral endplates and/or disposed at an angularorientation that matches lordosis. In some embodiments, the interbodyimplant includes one or more troughs disposed parallel to vertebralengaging surfaces of the implant and/or vertebral endplates, parallel toan axial or transverse plane of vertebrae, at a selected angularorientation relative to the vertebral engaging surfaces and/or at aselected angular orientation relative to vertebral endplates or theaxial or transverse planes, or at an angular orientation that matcheslordosis. In some embodiments, the interbody implant includes one ormore troughs disposed parallel to an axial plane of vertebrae. In someembodiments, the interbody implant includes one or more troughs having aposterior portion disposed parallel to vertebral engaging surfaces,vertebral endplates and/or at an angular orientation that matcheslordosis, and an anterior portion disposed parallel to an axial plane ortransverse plane of vertebrae.

In some embodiments, the surgical system includes an interbody implanthaving one or more troughs disposed with a superior surface thereof. Insome embodiments, the surgical system includes an interbody implanthaving one or more troughs disposed with an inferior surface thereof. Insome embodiments, the trough has a linear configuration and is disposedin an anterior to posterior orientation on one or more endplate engagingsurfaces of the interbody implant. In some embodiments, the trough has alinear configuration and is disposed in a lateral orientation on one ormore endplate engaging surfaces of the interbody implant. In someembodiments, the trough has a linear configuration and is disposed in anoblique orientation relative to a sagittal or coronal body plane on oneor more endplate engaging surfaces of the interbody implant. In someembodiments, the trough is disposed with a midline of the interbodyimplant. In some embodiments, the trough is disposed offset from amidline of the interbody implant.

In some embodiments, the surgical system includes an interbody implanthaving a trough disposed with a superior surface and a trough disposedwith an inferior surface, the troughs being disposed in an anterior toposterior orientation. In some embodiments, the surgical system includesan interbody implant having a trough disposed with a superior surfaceand a trough disposed with an inferior surface, the troughs beingdisposed in a lateral orientation. In some embodiments, the trough is 5millimeters (mm) wide and 1 mm deep. In some embodiments, the superiorsurface of the interbody implant that includes the trough has a 3.0 mmradius edge that defines the trough. In some embodiments, the trough is4.5 mm wide and has a depth in a range of 0.6 to 0.8 mm.

In some embodiments, the interbody implant includes an interbody cage.In some embodiments, the surgical system includes a plate that isaffixed to an interbody implant and a superior vertebral body and/or aninferior vertebral body adjacent an interbody space of vertebrae. Insome embodiments, the surgical system includes an interbody implantconnected with a plate, locks and/or insertion mechanisms. In someembodiments, the surgical system includes one or more radiographicmarkers selectively disposed with one or more components of the surgicalsystem. In some embodiments, the surgical system includes ahyper-lordotic interbody implant configured to achieve lordosis ofvertebrae in a range of 0 to 30 angular degrees.

In some embodiments, the surgical system is used with medical imaging,such as, for example, fluoroscopy, CT, MRI or other imaging techniques,which may comprise microsurgical and image guided technologies, such as,for example, a surgical navigation system employing emitters andsensors, which may be employed to track the components of the surgicalsystem. See, for example, the surgical navigation components and theiruse, as described in U.S. Pat. Nos. 6,021,343, 6,725,080 and 6,7969,88,the entire contents of each of these references being incorporated byreference herein. In some embodiments, one or all of the components ofthe surgical system are disposable, peel-pack, pre-packed steriledevices. One or all of the components of the surgical system may bereusable. The surgical system may be configured as a kit with multiplesized and configured components.

In some embodiments, the present disclosure may be employed to treatspinal disorders such as, for example, degenerative disc disease, discherniation, osteoporosis, spondylolisthesis, stenosis, scoliosis andother curvature abnormalities, kyphosis, tumor and fractures. In someembodiments, the present disclosure may be employed with other ostealand bone related applications, including those associated withdiagnostics and therapeutics. In some embodiments, the disclosedsurgical system may be alternatively employed in a surgical treatmentwith a patient in a prone or supine position, and/or employ varioussurgical approaches to the spine, including anterior, posterior,posterior mid-line, direct lateral, postero-lateral, and/or anterolateral approaches, and in other body regions. The present disclosuremay also be alternatively employed with procedures for treating thelumbar, cervical, thoracic, sacral and pelvic regions of a spinalcolumn. The system and methods of the present disclosure may also beused on animals, bone models and other non-living substrates, such as,for example, in training, testing and demonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. In some embodiments, as used inthe specification and including the appended claims, the singular forms“a,” “an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), employingimplantable devices, and/or employing instruments that treat thedisease, such as, for example, microdiscectomy instruments used toremove portions bulging or herniated discs and/or bone spurs, in aneffort to alleviate signs or symptoms of the disease or condition.Alleviation can occur prior to signs or symptoms of the disease orcondition appearing, as well as after their appearance. Thus, treatingor treatment includes preventing or prevention of disease or undesirablecondition (e.g., preventing the disease from occurring in a patient, whomay be predisposed to the disease but has not yet been diagnosed ashaving it). In addition, treating or treatment does not require completealleviation of signs or symptoms, does not require a cure, andspecifically includes procedures that have only a marginal effect on thepatient. Treatment can include inhibiting the disease, e.g., arrestingits development, or relieving the disease, e.g., causing regression ofthe disease. For example, treatment can include reducing acute orchronic inflammation; alleviating pain and mitigating and inducingre-growth of new ligament, bone and other tissues; as an adjunct insurgery; and/or any repair procedure. As used in the specification andincluding the appended claims, the term “tissue” includes soft tissue,ligaments, tendons, cartilage and/or bone unless specifically referredto otherwise.

The following discussion includes a description of a surgical system andrelated methods of employing the surgical system in accordance with theprinciples of the present disclosure. Alternate embodiments are alsodisclosed. Reference is made in detail to the exemplary embodiments ofthe present disclosure, which are illustrated in the accompanyingfigures. Turning to FIGS. 1-14, there are illustrated components of asurgical system, such as, for example, a spinal implant system 10.

The components of spinal implant system 10 can be fabricated frombiologically acceptable materials suitable for medical applications,including metals, synthetic polymers, ceramics and bone material and/ortheir composites. For example, the components of spinal implant system10, individually or collectively, can be fabricated from materials suchas stainless steel alloys, commercially pure titanium, titanium alloys,Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys,superelastic metallic alloys (e.g., Nitinol, super elasto-plasticmetals, such as GUM METAL®), ceramics and composites thereof such ascalcium phosphate (e.g., SKELITE™), thermoplastics such aspolyaryletherketone (PAEK) including polyetheretherketone (PEEK),polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEKcomposites, PEEK-BaSO₄ polymeric rubbers, polyethylene terephthalate(PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers,polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigidmaterials, elastomers, rubbers, thermoplastic elastomers, thermosetelastomers, elastomeric composites, rigid polymers includingpolyphenylene, polyamide, polyimide, polyetherimide, polyethylene,epoxy, bone material including autograft, allograft, xenograft ortransgenic cortical and/or corticocancellous bone, and tissue growth ordifferentiation factors, partially resorbable materials, such as, forexample, composites of metals and calcium-based ceramics, composites ofPEEK and calcium based ceramics, composites of PEEK with resorbablepolymers, totally resorbable materials, such as, for example, calciumbased ceramics such as calcium phosphate such as hydroxyapatite (HA),corraline HA, biphasic calcium phosphate, tricalcium phosphate, orfluorapatite, tri-calcium phosphate (TCP), HA-TCP, calcium sulfate, orother resorbable polymers such as polyaetide, polyglycolide,polytyrosine carbonate, polycaroplaetohe and their combinations,biocompatible ceramics, mineralized collagen, bioactive glasses, porousmetals, bone particles, bone fibers, morselized bone chips, bonemorphogenetic proteins (BMP), such as BMP-2, BMP-4, BMP-7, rhBMP-2, orrhBMP-7, demineralized bone matrix (DBM), transforming growth factors(TGF, e.g., TGF-β), osteoblast cells, growth and differentiation factor(GDF), insulin-like growth factor 1, platelet-derived growth factor,fibroblast growth factor, or any combination thereof.

Various components of spinal implant system 10 may have materialcomposites, including the above materials, to achieve various desiredcharacteristics such as strength, rigidity, elasticity, compliance,biomechanical performance, durability and radiolucency or imagingpreference. The components of spinal implant system 10, individually orcollectively, may also be fabricated from a heterogeneous material suchas a combination of two or more of the above-described materials. Thecomponents of spinal implant system 10 may be monolithically formed,integrally connected or include fastening elements and/or instruments,as described herein.

Spinal implant system 10 is employed, for example, with a fully opensurgical procedure, a minimally invasive procedure, includingpercutaneous techniques, and mini-open surgical techniques to deliverand introduce instrumentation and/or an implant, such as, for example,an interbody implant, at a surgical site of a patient, which includes,for example, a spine having vertebrae V (FIGS. 15-18). In someembodiments, a surgical pathway P to a surgical site is formed viavarious procedures, such as, for example, an oblique lateral interbodyfusion (OLIF), a direct lateral interbody fusion (DLIF), a posteriorlumbar interbody fusion (PLIF), an anterior lumbar interbody fusion(ALIF), an oblique lateral interbody fusion at L2-L5 (OLIF25), anoblique lateral interbody fusion at L5-S1 (OLIF51), a trans-psoas, ananterior, a lateral, an oblique, a retroperitoneal, or an ante-psoasprocedures. In some embodiments, spinal implant system 10 is employedwith a Smith-Petersen osteotomy, a Ponte-type osteotomy, a chevron-typeosteotomy, a partial facet joint resection, a complete facet jointresection for removal of posterior-most bony structures, as describedherein. In some embodiments, surgical system 10 can be employed withvarious surgical approaches to the spine, including anterior, posterior,posterior mid-line, direct lateral, postero-lateral, and/orantero-lateral approaches. In some embodiments, these approaches may bedone in isolation, sequentially or simultaneously. In some embodiments,the implant can include spinal constructs, such as, for example, bonefasteners, spinal rods, connectors and/or plates.

Spinal implant system 10 includes an implant body, such as, for example,an interbody cage 12, as shown in FIGS. 1-3. Cage 12 extends between aposterior surface 14 and an anterior surface 16 and defines an axis L1.Posterior surface 14 is configured to face a posterior side of a subjectbody and be disposed adjacent a posterior portion of vertebrae, such as,for example, a posterior portion P1 of one or more intervertebral spacesof vertebrae V (FIGS. 15-18). Anterior surface 16 is configured to facean anterior side of subject body and be disposed adjacent an anteriorportion of vertebrae, such as, for example an anterior portion A1 of oneor more intervertebral spaces of vertebrae V.

In some embodiments, cage 12 includes a convex distal end, such as, forexample, a bullet nose 18 to facilitate insertion by a surgeon. In someembodiments, cage 12 may include chamfers, such as, for example, cutouts 20 a, 20 b disposed on bullet nose 18 such that cage 12 may beplaced in an intervertebral space to avoid impinging on variousstructures in or adjacent vertebral tissue, such as, for example, aspinal foramina.

Cage 12 includes a vertebral engaging surface 22 and a vertebralengaging surface 24. Surface 22 may be substantially planar andconfigured to engage endplate tissue of a vertebral body, such as, forexample, an endplate E1 of a vertebral level V1 (FIG. 16). Surface 24may be substantially planar and configured to engage endplate tissue ofa vertebral body, such as, for example, an endplate E2 of a vertebrallevel V2 (FIG. 16). In some embodiments, surface 22 and/or surface 24may be rough, textured, porous, semi-porous, dimpled, knurled, toothed,grooved and/or polished to facilitate engagement with tissue. In someembodiments, one or more surfaces of cage 12 includes micro-texture toavoid subsidence with tissue. In some embodiments, surface 22 and/orsurface 24 may comprise a cephalad and/or a caudal oriented surface.

In some embodiments, surface 22 and/or surface 24 may be partiallyconvex along axis L1 and/or at least partially convex in a directionsubstantially perpendicular to an axis L2 (i.e., from surface 16 tosurface 14). In some embodiments, surface 22 and/or surface 24 may beangled along axis L1 or angled perpendicular to axis L1 such thatanterior surface 16 is taller than posterior surface 14 such that cage12 may be capable of creating and/or augmenting lateral or lordoticcurvature in a spine when implanted. In some embodiments, surface 22 andsurface 24 are disposed at a relative angular orientation to include ahyper-lordotic configuration to correct lumbar lordosis in situationswhere a natural curve of a lumbar region of the back is accentuated. Insome embodiments, surface 22 and surface 24 are disposed at a relativeangular orientation in a range of greater than 12 degrees.

In some embodiments, vertebral tissue includes intervertebral tissue,endplate surfaces and/or cortical bone. In some embodiments, surface 22and/or surface 24 may be coated with materials suitable for facilitatingor encouraging bony ongrowth or fusion including but not limited totitanium and HA coatings. In some embodiments, a titanium coating isapplied to surface 22 and/or surface 24 in a porous layer using plasmaspray technology.

Surface 22 defines a cavity, such as, for example, a groove 224. Groove224 is configured to provide indicia of bone growth, as describedherein. In some embodiments, groove 224 includes a trough configurationfor disposal of bone growth. Groove 224 extends between an end 226 andan end 228. End 226 is disposed adjacent anterior surface 16 and end 228is disposed adjacent posterior surface 14 such that groove 224 extendsin an anterior to posterior orientation along surface 22. In someembodiments, groove 224 extends along only a portion or the entiresurface 22 between surfaces 14, 16.

The portion of surface 22 that defines groove 224 comprises indicia thatfacilitates detecting bone growth in and/or through groove 224 andsurface 22 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 224, for example, during fusion. In some embodiments, groove224 includes a linear configuration disposed along surface 22. In someembodiments, all or only a portion of groove 224 may extend alongsurface 22 in alternate orientations, such as, for example, arcuate,undulating, irregular, uniform, non-uniform, offset, staggered, and/ortapered. In some embodiments, groove 224 can include various crosssections, such as, for example, oval, oblong, triangular, square,polygonal, irregular, uniform, non-uniform, variable and/or tapered. Insome embodiments, all or only a portion of surface 22 may have alternatesurface configurations, such as, for example, rough, arcuate,undulating, mesh, porous, semi-porous, dimpled and/or textured. In someembodiments, groove 224 includes an arcuate surface configurationconfigured to facilitate bone growth.

Surface 22 defines a groove 250, as shown in FIG. 8, similar to groove224 described herein. Groove 250 extends between an end 252 and an end254, and in a medial to lateral orientation along surface 22 and axisL1. Groove 250 extends transverse to groove 224 to intersect andcommunicate therewith. The portion of surface 22 that defines groove 250comprises indicia that facilitates detecting bone growth in and/orthrough groove 250 and surface 22 via medical imaging, as describedherein. The indicia is configured to facilitate visualization of aprogression of bone growth into groove 250, for example, during fusion.In some embodiments, groove 250 may be disposed at alternateorientations, relative to groove 224, such as, for example,perpendicular and/or other angular orientations, such as acute orobtuse, and/or may be separate, spaced apart, offset or staggered.

Surface 24 defines a groove 324, as shown in FIG. 3, similar to groove224 described herein. Groove 324 extends in an anterior to posteriororientation along surface 24. The portion of surface 24 that definesgroove 324 comprises indicia that facilitates detecting bone growth inand/or through groove 324 and surface 24 via medical imaging, asdescribed herein. The indicia is configured to facilitate visualizationof a progression of bone growth into groove 324, for example, duringfusion. In some embodiments, groove 324 may be disposed at alternateorientations, relative to groove 224 and/or groove 250, as describedherein.

Surface 22 defines a groove 350, as shown in FIG. 8, similar to groove224 described herein. Groove 350 extends in a medial to lateralorientation along surface 24 and axis L1. Groove 350 extends transverseto groove 324 to intersect and communicate therewith. The portion ofsurface 24 that defines groove 350 comprises indicia that facilitatesdetecting bone growth in and/or through groove 350 and surface 24 viamedical imaging, as described herein. The indicia is configured tofacilitate visualization of a progression of bone growth into groove350, for example, during fusion. In some embodiments, groove 350 may bedisposed at alternate orientations, relative to groove 224, groove 250and/or groove 324, as described herein.

In some embodiments, the indicia of surfaces 22, 24 that defines grooves224, 250, 324 and/or 350 comprise radiographic visual indicia. In someembodiments, the indicia includes radio-opaque material applied tosurface 22 and/or surface 24 in a predetermined pattern. In someembodiments, the indicia may include visual indicia, one or more viewingportals, tactile indicia, and/or one or more components having markersfor identification with medical imaging, as described herein. Duringfusion, bone grows into and around cage 12 to fuse the treatedvertebrae. Grooves 224, 250, 324, 350 are configured to provide a spaceof cage 12 for bone growth to develop and such bone growth beingidentified and/or detectable radiographically for assessment. Theindicia disposed with surfaces 22, 24 of grooves 224, 250, 324, 350facilitates providing visual data by medical imaging of a rate, amountand or progression of bone growth during fusion within, along or throughgrooves 224, 250, 324, 350 (FIG. 18).

In some embodiments, grooves 224, 324 include a width w1 ofapproximately 5.0 mm, as shown in FIG. 4. In some embodiments, grooves224, 324 include a depth d1 wide of approximately 1.0 mm. In someembodiments, grooves 224, 324 include edges having a radius R3 of 3.0mm, as shown in FIGS. 5 and 6. In some embodiments, grooves 250, 350include a width w2 of approximately 4.5 mm, as shown in FIG. 7. In someembodiments, grooves 250, 350 include a depth d2 in a range of 0.6 mm to0.8 mm. In some embodiments, depth d2 of grooves 250, 350 increases as aheight of cage 12 increases. In some embodiments, grooves 250, 350include edges having a radius of 3.0 mm.

In some embodiments, cage 12 includes a plurality of grooves 224 and/orgrooves 250, as described herein, disposed along axis L1, axis L2, aportion of surface 22, all of surface 22 or an entire area of surface 22to provide indicia, as described herein, of bone growth continuity atone or more selected locations of surface 22. In some embodiments, cage12 includes a plurality of grooves 224 and/or grooves 250 that arespaced apart. In some embodiments, cage 12 includes a plurality ofgrooves 224 and/or grooves 250 that are side by side, contiguous oradjacent. In some embodiments, cage 12 includes a plurality of grooves224 and/or grooves 250 that are disposed in a relatively parallelorientation. In some embodiments, cage 12 includes a plurality ofgrooves 224 and/or grooves 250 that are disposed in a relativelytransverse orientation and/or may intersect.

In some embodiments, cage 12 includes a plurality of grooves 324 and/orgrooves 350, as described herein, disposed along axis L1, axis L2, aportion of surface 24, all of surface 24 or an entire area of surface 24to provide indicia, as described herein, of bone growth continuity atone or more selected locations of surface 24. In some embodiments, cage12 includes a plurality of grooves 324 and/or grooves 350 that arespaced apart. In some embodiments, cage 12 includes a plurality ofgrooves 324 and/or grooves 350 that are side by side, contiguous oradjacent. In some embodiments, cage 12 includes a plurality of grooves324 and/or grooves 350 that are disposed in a relatively parallelorientation. In some embodiments, cage 12 includes a plurality ofgrooves 324 and/or grooves 350 that are disposed in a relativelytransverse orientation and/or may intersect.

Cage 12 includes a surface 400 that defines an opening 402, as shown inFIGS. 11 and 12. In some embodiments, opening 402 extends through athickness of cage 12, as shown in FIG. 11. Surface 400 includes indicia,similar to that described herein, for visualization by medical imaging,as described herein. The indicia is radiographically detectable toindicate orthogonal alignment of cage 12 relative to a bi-lateral axis Bof vertebrae, endplates and/or an intervertebral disc space, such thatopening 402 is disposable between a non-aligned orientation, as shown inFIG. 10, and an aligned orientation, as shown in FIG. 9. For example,when cage 12 is disposed relative to tissue in the non-alignedorientation, visualization of opening 402 is obstructed such thatsurface 400 is oriented to prevent radiographic visualization of opening402 through the body of cage 12, as shown in FIG. 12. When cage 12 isrotated relative to tissue to the aligned orientation, surface 400 isoriented to allow radiographic visualization of opening 402 through thebody of cage 12, as shown in FIG. 11. In some embodiments, opening 402is disposed in an anterior to posterior orientation. In someembodiments, opening 402 is disposed in a medial to lateral orientation.

In some embodiments, surface 14 defines a recess 412, as shown in FIGS.13 and 14. Recess 412 extends between nose 18 and a surface 44, asdescribed herein. Surface 14 includes indicia, similar to the indiciadescribed herein, for visualization by medical imaging, as describedherein. The indicia is radiographically detectable to indicateorthogonal alignment, as described herein, of cage 12 with tissue suchthat recess 412 is disposable between a non-aligned orientation and analigned orientation. For example, when cage 12 is disposed relative totissue in the non-aligned orientation, visualization of recess 412 isobstructed such that surface 14 is oriented to prevent radiographicvisualization of recess 412 through the body of cage 12, as shown inFIG. 14. When cage 12 is rotated relative to tissue to the alignedorientation, surface 14 is oriented to allow radiographic visualizationof recess 412 through the body of cage 12, as shown in FIG. 13. In someembodiments, recess 412 is disposed in a medial to lateral orientation.In some embodiments, recess 412 is disposed in an anterior to posteriororientation.

In some embodiments, cage 12 includes any number and configuration ofradiopaque markers (such as tantalum pins (not shown)) for visualizing aposition and/or alignment of cage 12 using fluoroscopy during insertion,manipulation and implantation thereof. In some embodiments, the markersmay be placed obliquely on bullet nose 18, in sidewalls of cage 12adjacent surfaces 14, 16 and/or in a proximal end of cage 12. In someembodiments, the markers may be placed parallel, oblique to and/orperpendicular to surfaces 14, 16 as required to properly visualize theposition of cage 12 relative to surgical pathway P to facilitateplacement of cage 12, as described herein.

Cage 12 has a substantially rectangular configuration and includes aninner surface 26. Surface 26 defines lateral openings 30 configured toreceive an agent, which may include bone graft (not shown) and/or othermaterials, as described herein, for employment in a fixation or fusiontreatment. Surface 22 and surface 24 each include a plurality ofhexagonal openings 31 such that surfaces 22, 24 each define a honeycombconfiguration, as shown in FIGS. 1 and 2. Surfaces 22, 24 are configuredfor disposal of fluids, bone graft and/or bone growth through openings31. A portion of openings 31 are disposed with one or more of grooves224, 250, 324, 350 for bone growth therein. In some embodiments, one ormore of openings 31 may be alternately shaped, such as, for example,polygonal including triangular, quadrilateral, pentagonal, arcuatewalls.

Cage 12 includes an oblique surface 44 that defines an elongated openingincluding a track 46. Oblique surface 44 is oriented with cage 12 and insubstantial alignment with surgical pathway P (FIG. 15). Track 46 is inopen communication with surface 44 to define a track pathway 48 thatfacilitates translation and/or rotation of a plate connected with cage12, as described herein. In some embodiments, pathway 48 is arcuate inshape. In some embodiments, track 46 includes a varying radius ofcurvature. Track 46 includes a limit of a range of translation of anattached implant, such as, for example, a plate 60 relative to cage 12along track 46 and/or pathway 48, as described herein.

Cage 12 includes a connection mechanism, such as, for example, a slider54 configured to connect cage 12 with a surgical instrument and/or plate60. In some embodiments, slider 54 includes a connecting member, suchas, for example, a head 92 having an elongated post 94. Head 92 isconfigured for engagement with and translation along track 46. In someembodiments, post 94 includes a threaded surface configured tofacilitate engagement with the surgical instrument. In some embodiments,a dovetail or t-slot sliding attachment mechanism can be utilized. Insome embodiments, track 46 and surface 44 are arcuate with each having asingle radii. In some embodiments, track 46 and surface 44 have multipleradii.

Slider 54 is slidably engageable with track 46 and/or plate 60 fortranslation relative to cage 12 along track pathway 48. Slider 54 ismovable along track pathway 48 for translation substantially along axisL2 and/or transverse to axis L1. Slider 54 is movable along trackpathway 48 for rotation about axis L2 and/or axis L1. In someembodiments, track pathway 48 extends along an arcuate configurationthat is substantially concentric with track 46 and/or a lateral surfaceof cage 12.

Plate 60 includes a portion configured to engage a vertebral level. Insome embodiments, a surgical instrument or tool, as described herein,manipulates and/or rotates plate 60 about cage 12 and/or tissue foralignment with selected vertebral tissue, for example, a superiorvertebral body such as vertebral level V1 or an inferior vertebral bodysuch as vertebral level V2 for orienting a fastener for fixation of cage12 and/or plate 60 with the selected vertebral level. In someembodiments, plate 60 may be attached with cage 12 prior toimplantation, in vivo or in situ. In some embodiments, plate 60 isremovably connected with cage 12.

Spinal implant system 10 includes one or more fasteners (not shown) forattaching plate 60 and/or cage 12 to tissue, as described herein. Insome embodiments, the fastener may be engaged with tissue, such as, forexample, the bony structures of a vertebral body in variousorientations, such as, for example, series, parallel, offset, staggeredand/or alternate vertebral levels. In some embodiments, one or more offasteners may comprise multi-axial screws, sagittal angulation screws,pedicle screws, mono-axial screws, uni-planar screws, facet screws,fixed screws, tissue penetrating screws, conventional screws, expandingscrews, wedges, anchors, buttons, clips, snaps, friction fittings,compressive fittings, expanding rivets, staples, nails, adhesives,posts, fixation plates and/or posts. In some embodiments, spinal implantsystem 10 may comprise various surgical instruments, such as, forexample, drivers, extenders, reducers, spreaders, distracters, blades,forceps, elevators and drills, which may be alternately sized anddimensioned, and arranged as a kit.

In assembly, operation and use, as shown in FIGS. 15-18, spinal implantsystem 10, similar to the systems and methods described herein, isemployed with a surgical procedure for treatment of a spinal disorder,such as those described herein, affecting a section of a spine of apatient. The components of spinal implant system 10 are employed with asurgical procedure for treatment of a spinal disorder affecting asection of a spine of a patient, for example, to treat the affectedsection of vertebrae V of a patient utilizing an OLIF or DLIF procedure.Vertebrae V defines a transverse and/or axial plane A2 and bi-lateralaxis B.

A retractor (not shown) is disposed in communication with surgicalpathway P for spacing tissue. In some embodiments, an annulotomy and/ordiscectomy is performed with a surgical instrument with x-rayconfirmation of the starting point that is central on one or moreintervertebral spaces. A probe is passed into the disc space to secureits location. In some embodiments, the oblique angle and lordotic angleof the probe as it enters the disc space is assessed pre-operatively andmeasured intra-operative using image guidance or using a mechanical ordigital protractor. Fluoroscopy, image guidance and/or surgicalnavigation, as described herein, is used to confirm proper probealignment into the disc space. In some embodiments, a guide wire isplaced through a cannula into the disc space and positioning isconfirmed with fluoroscopy. Instruments, such as, for example, a Cobb,mallet, shaver, serrated curettes, rasp, a ring curette, a uterinecurette and/or combo tools are utilized to perform a discectomy of thedisc space. The instruments enter the patient body obliquely through theretractor and can be turned orthogonally to allow the surgeon to workorthogonally across the disc space. The disc space is distracted untiladequate disc space height is obtained.

In some embodiments, a discectomy is performed via surgical pathway P.In some embodiments, trial implants are delivered along surgical pathwayP and used to distract one or more intervertebral spaces and applyappropriate tension in the intervertebral space allowing for indirectdecompression. In some embodiments, a direct decompression of the discspace is performed by removing a portion of a herniated disc. In someembodiments, the size of cage 12 is selected after trialing and cage 12is visualized by fluoroscopy and oriented before malleting into theintervertebral space. Trialing is utilized to establish a starting pointfor cage 12 insertion. In some embodiments, an anterior longitudinalligament (ALL) release procedure can be performed using an OLIF or aDLIF approach post-discectomy. For example, loosening the ALL can beperformed by placing holes or partial cuts in the ALL such that the OLIFsurgical pathway is immediately closer to the ALL.

A pilot hole(s) or the like is made in selected vertebra V1 of vertebraeV adjacent an intervertebral space S, via surgical pathway P, forreceiving a bone fastener, as described herein. Inserter I is attachedwith cage 12 and/or plate 60, as described herein. Inserter I deliverscage 12 and plate 60 along surgical pathway P adjacent to a surgicalsite for implantation adjacent intervertebral space S between vertebraeV1 and V2. In some embodiments, inserter I includes a navigationcomponent to facilitate placement of cage 12 and plate 60 betweenvertebrae V1, V2. In some embodiments, inserter I includes one or moremetallic portions engageable and/or connectable with one or moremetallic portions of cage 12 and plate 60. As such, the metal on metalengagement and/or connection of inserter I, cage 12 and/or plate 60provides more rigidity and control for selected or compatible insertionangulation of inserter I, cage 12 and/or plate 60 relative to a surgicalapproach, inserter I and/or implant axis. In some embodiments, the metalon metal engagement and/or connection of inserter I, cage 12 and/orplate 60 resists and/or prevents deformation or bending at the inserterI, cage 12 and/or plate 60 interface. For example, during an insertiontechnique using an OLIF surgical approach, cage 12 may requireangulation and/or rotation from an anterior incision to, for example, anL45 disc such that the interface of metallic surfaces of inserter I andcage 12 provide a rigid connection and control for resisting and/orpreventing deformation or bending at the interface.

During insertion, inserter I is attached with plate 60 to manipulateplate 60 relative to cage 12. Cage 12 and plate 60 are inserted throughthe retractor adjacent the surgical site. Anterior surface 16 faces ananterior side of the patient body adjacent anterior portion A1 andposterior surface 14 faces a posterior side of the patient body adjacentposterior portion P1, as described herein. Surface 22 engages endplatetissue of endplate E1 and surface 24 engages endplate tissue of endplateE2.

Inserter I is attached with cage 12 to manipulate cage 12 intoorthogonal alignment with bi-lateral axis B such that axis L1 isoriented perpendicular relative to axis B for selective positioning ofcage 12 with intervertebral space S. Cage 12 comprises opening 402,which comprises indicia that is radiographically detectable to indicateorthogonal alignment of cage 12 relative to axis B. For example, from anon-aligned orientation, as described herein and shown in FIG. 12, cage12 is rotated with inserter I relative to endplates E1, E2 and discspace S to an aligned orientation such that surface 400 is oriented toallow radiographic visualization of opening 402 through the body of cage12, as shown in FIGS. 11 and 15. In some embodiments, from a non-alignedorientation, as described herein and shown in FIG. 14, cage 12 isrotated with inserter I relative to endplates E1, E2 and disc space S toan aligned orientation such that surface 14 is oriented to allowradiographic visualization of recess 412 through the body of cage 12, asshown in FIGS. 13 and 15. In some embodiments, cage 12 can beselectively aligned with endplates E1, E2 and disc space S in alternateorientations relative to axis B, for example, angular orientationsand/or offset.

In some embodiments, spinal implant system 10 includes an agent, whichmay be disposed, packed, coated or layered within, on or about thecomponents and/or surfaces of cage 12. In some embodiments, the agentmay include bone growth promoting material, such as, for example, bonegraft to enhance fixation of the components and/or surfaces of cage 12with vertebrae. In some embodiments, the agent may include one or aplurality of therapeutic agents and/or pharmacological agents forrelease, including sustained release, to treat, for example, pain,inflammation and degeneration.

After positioning of cage 12 with endplates E1, E2 and disc space S,plate 60 is rotated into position relative to vertebrae V1, V2.Translation and rotation of plate 60 allows selective manipulation ofplate 60 to facilitate plate 60 positioning relative to vertebrae V1,V2. In some embodiments, inserter I or other surgical instruments, asdescribed herein, engages plate 60 to rotate plate 60, in a clockwise orcounter-clockwise direction, for alignment and orienting a fastener forfixation of cage 12 and/or plate 60 with vertebral levels V1, V2.

Fasteners are aligned with tissue, and inserted along inserter I via adriver (not shown). Fasteners engage vertebra V1 and/or vertebra V2. Thedriver is configured to drive, torque, insert or otherwise fastenfasteners with vertebrae V1, V2 adjacent intervertebral space S. In someembodiments, the driver may include surgical navigation components, asdescribed herein, to establish a pathway for the fastener that issubstantially concurrent with and/or parallel to the surgical approachangle. In some embodiments, plate 60 is fixed with fasteners at anoblique angle relative to cage 12. In some embodiments, plate 60 isfixed with fasteners laterally with cage 12. Upon completion of aprocedure, as described herein, the surgical instruments, assemblies andnon-implanted components of spinal implant system 10 are removed and theincision(s) are closed.

Upon completion of the procedure, as described above, identification,confirmation and/or assessment of regeneration of natural bone tissueand/or successful bone grafting within, on or about the surfaces of cage12 can be performed via medical imaging in a subsequent procedure and/orexamination of the surgical site to assess treatment. For example,medical imaging, as described herein, is employed to radiographicallydetect the indicia of grooves 224, 250, 324, 350, as described herein,for detecting bone growth BG in and through grooves 224, 250, 324, 350,as shown in FIG. 18. The indicia of grooves 224, 250, 324, 350 providevisualization to confirm and/or assess the rate, amount and/orprogression of bone growth between endplates E1, E2 and surfaces 22, 24.As such, the indicia of grooves 224, 250, 324, 350 provide a visualassessment of fusion of vertebral levels V1, V2 with cage 12, as well asthe progression of bone growth BG and/or migration into grooves 224,250, 324, 350.

In one embodiment, as shown in FIGS. 19-21, spinal implant system 10,similar to the systems and methods described herein, includes a cage512, similar to cage 12 described herein. Cage 512 includes a surface522, similar to surface 22 described herein. Surface 522 defines agroove 624, similar to groove 224 described herein. Groove 624 extendsin an anterior to posterior orientation along surface 522. Groove 624extends along surface 522 such that all or only a portion of groove 624is disposed in a parallel orientation relative to endplate E1, endplateE2 and/or a selected lordosis of vertebrae V (FIGS. 15-18). The portionof surface 522 that defines groove 624 comprises indicia thatfacilitates detecting bone growth in and/or through groove 624 andsurface 522 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 624, for example, during fusion. In some embodiments,surface 522 may define one or a plurality of grooves 624, which may bedisposed at alternate relative orientations, as described herein.

Cage 512 includes a surface 524, similar to surface 24 described herein.Surface 524 defines a groove 724, similar to groove 224 describedherein. Groove 724 extends in an anterior to posterior orientation alongsurface 524. Groove 724 extends along surface 524 such that all or onlya portion of groove 724 is disposed in a parallel orientation relativeto endplate E1, endplate E2 and/or a selected lordosis of vertebrae V(FIGS. 15-18). The portion of surface 524 that defines groove 724comprises indicia that facilitates detecting bone growth in and/orthrough groove 724 and surface 524 via medical imaging, as describedherein. The indicia is configured to facilitate visualization of aprogression of bone growth into groove 724, for example, during fusion.In some embodiments, groove 724 may be disposed at alternateorientations, relative to groove 624, as described herein. In someembodiments, surface 524 may define one or a plurality of grooves 724,which may be disposed at alternate relative orientations, as describedherein. In some embodiments, cage 512 includes a slider 554, similar toslider 54 described herein, configured to connect cage 512 with asurgical instrument and/or plate 60.

In one embodiment, as shown in FIGS. 22-24, spinal implant system 10,similar to the systems and methods described herein, includes a cage812, similar to cage 12 described herein. Cage 812 includes a surface822, similar to surface 22 described herein. Surface 822 defines agroove 924, similar to groove 224 described herein. Groove 924 extendsin an anterior to posterior orientation along surface 822. Groove 924extends along surface 822 such that all or only a portion of groove 924is disposed at a selected angular orientation relative to endplate E1,endplate E2, a selected lordosis of vertebrae V, bi-lateral axis Band/or an axial plane of vertebrae V (FIGS. 15-18). For example, all oronly a portion of groove 924 can be disposed at a selected angularorientation between endplates E1, E2 and an axial plane of vertebrae V.The portion of surface 822 that defines groove 924 comprises indiciathat facilitates detecting bone growth in and/or through groove 924 andsurface 822 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 924, for example, during fusion. In some embodiments,surface 822 may define one or a plurality of grooves 924, which may bedisposed at alternate relative orientations, as described herein.

Cage 812 includes a surface 824, similar to surface 24 described herein.Surface 824 defines a groove 1024, similar to groove 224 describedherein. Groove 1024 extends in an anterior to posterior orientationalong surface 824. Groove 1024 extends along surface 824 such that allor only a portion of groove 1024 is disposed at a selected angularorientation relative to endplate E1, endplate E2, a selected lordosis ofvertebrae V, bi-lateral axis B and/or an axial plane of vertebrae V(FIGS. 15-18). For example, all or only a portion of groove 1024 can bedisposed at a selected angular orientation between endplates E1, E2 andan axial plane of vertebrae V. The portion of surface 824 that definesgroove 1024 comprises indicia that facilitates detecting bone growth inand/or through groove 1024 and surface 824 via medical imaging, asdescribed herein. The indicia is configured to facilitate visualizationof a progression of bone growth into groove 1024, for example, duringfusion. In some embodiments, groove 1024 may be disposed at alternateorientations, relative to groove 924, as described herein. In someembodiments, surface 824 may define one or a plurality of grooves 1024,which may be disposed at alternate relative orientations, as describedherein. In some embodiments, cage 812 includes a slider 854, similar toslider 54 described herein, configured to connect cage 812 with asurgical instrument and/or plate 60.

In one embodiment, as shown in FIGS. 25-27, spinal implant system 10,similar to the systems and methods described herein, includes a cage1112, similar to cage 12 described herein. Cage 1112 includes a surface1122, similar to surface 22 described herein. Surface 1122 defines agroove 1224, similar to groove 224 described herein. Groove 1224 extendsin an anterior to posterior orientation along surface 1122. Groove 1224extends along surface 1122 such that all or only a portion of groove1224 is disposed in a parallel orientation relative to bi-lateral axis Band/or an axial plane of vertebrae V (FIGS. 15-18). The portion ofsurface 1122 that defines groove 1224 comprises indicia that facilitatesdetecting bone growth in and/or through groove 1224 and surface 1122 viamedical imaging, as described herein. The indicia is configured tofacilitate visualization of a progression of bone growth into groove1224, for example, during fusion. In some embodiments, surface 1122 maydefine one or a plurality of grooves 1224, which may be disposed atalternate relative orientations, as described herein.

Cage 1112 includes a surface 1124, similar to surface 24 describedherein. Surface 1124 defines a groove 1324, similar to groove 224described herein. Groove 1324 extends in an anterior to posteriororientation along surface 1124. Groove 1324 extends along surface 1124such that all or only a portion of groove 1324 is disposed in a parallelorientation relative to bi-lateral axis B and/or an axial plane ofvertebrae V (FIGS. 15-18). The portion of surface 1124 that definesgroove 1324 comprises indicia that facilitates detecting bone growth inand/or through groove 1324 and surface 1124 via medical imaging, asdescribed herein. The indicia is configured to facilitate visualizationof a progression of bone growth into groove 1324, for example, duringfusion. In some embodiments, groove 1324 may be disposed at alternateorientations, relative to groove 1224, as described herein. In someembodiments, surface 1124 may define one or a plurality of grooves 1324,which may be disposed at alternate relative orientations, as describedherein. In some embodiments, cage 1112 includes a slider 1154, similarto slider 54 described herein, configured to connect cage 1112 with asurgical instrument and/or plate 60.

In one embodiment, as shown in FIGS. 28-30, spinal implant system 10,similar to the systems and methods described herein, includes a cage1412, similar to cage 12 described herein. Cage 1412 includes a surface1422, similar to surface 22 described herein. Surface 1422 defines agroove 1524, similar to groove 224 described herein. Groove 1524 extendsin an anterior to posterior orientation along surface 1422 and includesa posterior portion 1526 and an anterior portion 1528. In someembodiments, portions 1526, 1528 are equal such that posterior portion1526 comprises a posterior half and anterior portion 1528 comprises ananterior half.

Groove 1524 extends along surface 1422 such that posterior portion 1526is disposed in a parallel orientation relative to endplates E1, E2 andanterior portion 1528 is disposed in a parallel orientation relative tobi-lateral axis B and/or an axial plane of vertebrae V (FIGS. 15-18).The portion of surface 1422 that defines groove 1524 comprises indiciathat facilitates detecting bone growth in and/or through groove 1524 andsurface 1422 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 1524, for example, during fusion. In some embodiments,surface 1422 may define one or a plurality of grooves 1524, which may bedisposed at alternate relative orientations, as described herein.

Cage 1412 includes a surface 1424, similar to surface 24 describedherein. Surface 1424 defines a groove 1624, similar to groove 224described herein. Groove 1624 extends in an anterior to posteriororientation along surface 1424 and includes a posterior portion 1626 andan anterior portion 1628. In some embodiments, portions 1626, 1628 areequal such that posterior portion 1626 comprises a posterior half andanterior portion 1628 comprises an anterior half.

Groove 1624 extends along surface 1424 such that posterior portion 1626is disposed in a parallel orientation relative to endplates E1, E2 andanterior portion 1628 is disposed in a parallel orientation relative tobi-lateral axis B and/or an axial plane of vertebrae V (FIGS. 15-18).The portion of surface 1424 that defines groove 1624 comprises indiciathat facilitates detecting bone growth in and/or through groove 1624 andsurface 1424 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 1624, for example, during fusion. In some embodiments,groove 1624 may be disposed at alternate orientations, relative togroove 1524, as described herein. In some embodiments, surface 1424 maydefine one or a plurality of grooves 1624, which may be disposed atalternate relative orientations, as described herein. In someembodiments, cage 1412 includes a slider 1454, similar to slider 54described herein, configured to connect cage 1412 with a surgicalinstrument and/or plate 60.

In one embodiment, as shown in FIGS. 31-36, spinal implant system 10,similar to the systems and methods described herein, includes a cage1712, similar to cage 12 described herein. Cage 1712 includes a surface1722, similar to surface 22 described herein. Surface 1722 defines agroove 1824, similar to groove 224 described herein. Groove 1824 extendsin an anterior to posterior orientation along surface 1722. Groove 1824extends along surface 1722 such that all or only a portion of groove1824 is disposed in a parallel orientation relative to endplate E1,endplate E2 and/or a selected lordosis of vertebrae V (FIGS. 15-18). Theportion of surface 1722 that defines groove 1824 comprises indicia thatfacilitates detecting bone growth in and/or through groove 1824 andsurface 1722 via medical imaging, as described herein. The indicia isconfigured to facilitate visualization of a progression of bone growthinto groove 1824, for example, during fusion. In some embodiments,surface 1722 may define one or a plurality of grooves 1824, which may bedisposed at alternate relative orientations, as described herein.

In some embodiments, surface 1722 defines a groove 1850, as shown inFIG. 34, similar to groove 250 described herein. Groove 1850 extends ina medial to lateral orientation along surface 1722, as described herein.Groove 1850 extends transverse to groove 1824 to intersect andcommunicate therewith. The portion of surface 1722 that defines groove1850 comprises indicia that facilitates detecting bone growth in and/orthrough groove 1850 and surface 1722 via medical imaging, as describedherein.

Cage 1712 includes a surface 1724, similar to surface 24 describedherein. Surface 1724 defines a groove 1924, similar to groove 224described herein. Groove 1924 extends in an anterior to posteriororientation along surface 1724. Groove 1924 extends along surface 1724such that all or only a portion of groove 1924 is disposed in a parallelorientation relative to endplate E1, endplate E2 and/or a selectedlordosis of vertebrae V, as described herein. The portion of surface1724 that defines groove 1924 comprises indicia that facilitatesdetecting bone growth in and/or through groove 1924 and surface 1724 viamedical imaging, as described herein. The indicia is configured tofacilitate visualization of a progression of bone growth into groove1924, for example, during fusion. In some embodiments, groove 1924 maybe disposed at alternate orientations, relative to groove 1824, asdescribed herein. In some embodiments, surface 1724 may define one or aplurality of grooves 1924, which may be disposed at alternate relativeorientations, as described herein.

Surface 1724 defines a groove 1950, as shown in FIG. 34, similar togroove 350 described herein. Groove 1950 extends in a medial to lateralorientation, as described herein. Groove 1950 extends transverse togroove 1924 to intersect and communicate therewith. The portion ofsurface 1724 that defines groove 1950 comprises indicia that facilitatesdetecting bone growth in and/or through groove 1950 and surface 1724 viamedical imaging, as described herein.

Cage 1712 includes a surface 2000 that defines an opening 2002, as shownin FIGS. 31 and 33 and similar to opening 402 as described herein.Surface 2000 includes indicia, similar to that described herein, forvisualization by medical imaging, as described herein. The indicia isradiographically detectable to indicate orthogonal alignment of cage1712 relative to a bi-lateral axis of vertebrae, endplates and/or anintervertebral disc space, such that opening 2002 is disposable betweena non-aligned orientation and an aligned orientation, as describedherein.

In some embodiments, a surface 1714 defines a recess 2012, as shown inFIGS. 35 and 36. Recess 2012 extends between a nose 1718 and a surface1744, as described herein. Surface 1714 includes indicia, similar to theindicia described herein, for visualization by medical imaging, asdescribed herein. The indicia is radiographically detectable to indicateorthogonal alignment, as described herein, of cage 1712 with tissue suchthat recess 2012 is disposable between a non-aligned orientation and analigned orientation, as described herein.

Cage 1712 includes oblique surface 1744 that defines an elongatedopening including a track 1746, similar to track 46 described herein.Cage 1712 includes a slider 1754, similar to slider 54, as describedherein.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as exemplification of thevarious embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

What is claimed is:
 1. An interbody implant comprising: an implant bodyextending along a longitudinal axis between opposite first and secondends, the implant body including an anterior surface and an oppositeposterior surface, the anterior and posterior surfaces each extendingfrom the first end to the second end, the implant body including asubstantially planar first vertebral engaging surface and an oppositesecond vertebral engaging surface, the first and second vertebralengaging surfaces each extending from the first end to the second endand from the anterior surface to the posterior surface, the implant bodyincluding an opening extending through the anterior and posteriorsurfaces, the first vertebral engaging surface defining only one grooveextending along the longitudinal axis and only one groove extendingtransverse to the longitudinal axis, the groove extending transverse tothe longitudinal axis being a first groove and the groove extendingalong the longitudinal axis being a second groove, the grooves eachextending into the first vertebral engaging surface without extendingthrough the second vertebral engaging surface, the second grooveextending transverse to the first groove to intersect and communicatewith the first groove, the grooves each being configured for disposal ofbone growth detectable via medical imaging, wherein the implant body isconfigured to be manipulated between a non-aligned orientation in whichvisualization of the opening is obstructed by a surface of the implantbody that prevents radiographic visualization of the opening and analigned orientation in which the surface is oriented to allowradiographic visualization of the opening.
 2. An interbody implant asrecited in claim 1, wherein the opening comprises radiographic visualindicia of disposal of the interbody implant in a selected alignmentwith tissue.
 3. An interbody implant as recited in claim 1, wherein theimplant body defines a recess extending into the posterior surface, therecess extending parallel to the anterior surface such that the recessis radiographically detectable in the aligned orientation and the recessis radiographically non-detectable in the non-aligned orientation.
 4. Aninterbody implant as recited in claim 1, wherein one or more of thesurfaces include a honeycomb configuration.
 5. An interbody implant asrecited in claim 1, wherein the first groove has a linear configurationand is disposed in an anterior to posterior orientation relative to thevertebral engaging surfaces.
 6. An interbody implant as recited in claim1, wherein the second groove has a linear configuration and is disposedin a lateral orientation relative to the vertebral engaging surfaces. 7.An interbody implant as recited in claim 1, further comprising a plateconnectable with the implant body via a coupling member and defining asingle opening oriented to implant a fastener with tissue.
 8. Aninterbody implant as recited in claim 1, wherein the first end defines abullet nose.
 9. An interbody implant as recited in claim 1, wherein: theimplant body includes an aperture in the second end and a trackextending through the first vertebral engaging surface such that thetrack is in communication with the aperture; and the implant comprises aslider having a head positioned in the track and a post positioned inthe aperture.
 10. An interbody implant as recited in claim 9, whereinthe head is configured for engagement and translation along the trackand the post is fixed to the head and comprises a threaded surfaceconfigured to facilitate engagement with a surgical instrument.
 11. Aninterbody implant as recited in claim 1, wherein the first grooveextends continuously from the anterior surface to the posterior surface.12. An interbody implant as recited in claim 1, wherein the first groovecomprises a first end extending through the anterior surface and anopposite second end extending through the posterior surface.
 13. Aninterbody implant as recited in claim 1, wherein the opening extendsparallel to the first groove.
 14. An interbody implant as recited inclaim 1, wherein the first vertebral engaging surface is free of anyteeth that extend outwardly from the first vertebral engaging surface.15. An interbody implant as recited in claim 1, wherein the firstvertebral engaging surface includes an area that extends from the secondgroove to an end surface of the first end and from the posterior surfaceto the anterior surface, the area being substantially planar.
 16. Aninterbody implant as recited in claim 1, wherein the first vertebralengaging surface includes an area that extends from the second groove toan end surface of the second end and from the posterior surface to theanterior surface, the area being substantially planar.
 17. An interbodyimplant as recited in claim 1, wherein the first vertebral engagingsurface includes a first area that extends from the second groove to anend surface of the first end and from the posterior surface to theanterior surface, the area being substantially planar, the firstvertebral engaging surface including a second area that extends from thesecond groove to an end surface of the second end and from the posteriorsurface to the anterior surface, the first and second areas each beingsubstantially planar.
 18. An interbody implant comprising: an implantbody extending along a longitudinal axis between opposite first andsecond ends, the implant body including an anterior surface and anopposite posterior surface, the anterior and posterior surfaces eachextending from the first end to the second end, the implant bodyincluding a substantially planar superior vertebral engaging surface andan opposite inferior vertebral engaging surface, the superior andinferior vertebral engaging surfaces each extending from the first endto the second end and from the anterior surface to the posteriorsurface, the implant body including an opening extending continuouslythrough the anterior and posterior surfaces, the superior vertebralengaging surface defining only one groove extending along thelongitudinal axis and only one groove extending transverse to thelongitudinal axis, the groove extending along the longitudinal axisbeing a first groove and the groove extending transverse to thelongitudinal axis being a second groove, the first and second grooveseach extending into the superior surface, the first groove having alinear configuration, the first groove being disposed in an anterior toposterior orientation relative to the superior surface, the secondgroove having a linear configuration and being disposed in a lateralorientation relative to the superior surface, the second grooveextending transverse to the first groove to intersect and communicatewith the first groove, and the inferior surface defining a third groovehaving a linear configuration and being disposed in an anterior toposterior orientation relative to the inferior surface, the inferiorsurface defining a fourth groove having a linear configuration and beingdisposed in a lateral orientation relative to the superior surface, thefourth groove extending transverse to the third groove to intersect andcommunicate with the third groove, the grooves being configured fordisposal of bone growth detectable via medical imaging, wherein theimplant body is configured to be manipulated between a non-alignedorientation in which visualization of the opening is obstructed by asurface of the implant body that prevents radiographic visualization ofthe opening and an aligned orientation in which the surface is orientedto allow radiographic visualization of the opening.
 19. An interbodyimplant as recited in claim 18, wherein the implant body comprises arecess extending into the posterior surface, the recess extendingparallel to the anterior surface such that the recess isradiographically detectable in the aligned orientation and the recess isradiographically non-detectable in the non-aligned orientation.
 20. Aninterbody implant comprising: an implant body extending along alongitudinal axis between opposite first and second ends, the implantbody including an anterior surface and an opposite posterior surface,the anterior and posterior surfaces each extending from the first end tothe second end, the implant body including a substantially planar firstvertebral engaging surface and an opposite second vertebral engagingsurface, the first and second vertebral engaging surface each extendingfrom the first end to the second end and from the anterior surface tothe posterior surface, the implant body including an opening extendingthrough the anterior and posterior surfaces and a recess extending intothe posterior surface, and the first vertebral engaging surface definingonly one trough extending along the longitudinal axis and only onetrough extending transverse to the longitudinal axis, the troughextending along the longitudinal axis being a first trough and thetrough extending transverse to the longitudinal axis being a secondtrough, the troughs each extending into the first vertebral engagingsurface, the troughs being configured for disposal of bone growth anddetectable to provide radiographic visual indicia, the second troughextending transverse to the first trough to intersect and communicatewith the first trough, wherein the implant body is configured to bemanipulated between a non-aligned orientation in which visualization ofthe opening is obstructed by a surface of the implant body that preventsradiographic visualization of the opening and an aligned orientation inwhich the surface is oriented to allow radiographic visualization of theopening, and wherein the recess extends parallel to the anterior surfacesuch that the recess is radiographically detectable in the alignedorientation and the recess is radiographically non-detectable in thenon-aligned orientation.
 21. A method for treating a spine, the methodcomprising the steps of: connecting a surgical instrument with animplant body adjacent a cavity of the implant body, the implant bodyextending between opposite first and second ends, the implant bodyincluding opposite anterior and posterior surfaces, the anterior andposterior surfaces each extending from the first end to the second end,the implant body including opposite first and second vertebral engagingsurfaces, the first and second vertebral engaging surfaces eachextending from the first end to the second end and from the anteriorsurface to the posterior surface, the implant body including an openingextending through the anterior and posterior surfaces and a recessextending into the posterior surface; disposing the implant body betweena first vertebral surface and a second vertebral surface of a subjectbody; manipulating the implant body between a non-aligned orientationsuch that visualization of the opening is obstructed by a surface of theimplant body that prevents radiographic visualization of the opening andan aligned orientation such that the surface is oriented to allowradiographic visualization of the opening; and manipulating the implantbody such that recess is detectable to indicate orthogonal alignment ofthe implant body with the vertebral surfaces.